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Amankulov J, Kaidarova D, Zholdybay Z, Zagurovskaya M, Baltabekov N, Gabdullina M, Ainakulova A, Toleshbayev D, Panina A, Satbayeva E, Kalieva Z. Colorectal Cancer Screening with Computed Tomography Colonography: Single Region Experience in Kazakhstan. Clin Endosc 2021; 55:101-112. [PMID: 34265195 PMCID: PMC8831409 DOI: 10.5946/ce.2021.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 05/18/2021] [Indexed: 12/24/2022] Open
Abstract
Background/Aims The aim of our study was to determine the efficacy of computed tomography colonography (CTC) in screening for colorectal cancer (CRC).
Methods A total of 612 females and 588 males aged 45 to 75 years were enrolled in CTC screening. CTC was performed following standard bowel preparation and colonic insufflation with carbon dioxide. The main outcomes were the detection rate of CRC and advanced adenoma (AA), prevalence of colorectal lesions in relation to socio-demographic and health factors, and overall diagnostic performance of CTC.
Results Overall, 56.5% of the 1,200 invited subjects underwent CTC screening. The sensitivity for CRC and AA was 0.89 and 0.97, respectively, while the specificity was 0.71 and 0.99, respectively. The prevalence of CRC and AA was 3.0% (18/593) and 7.1% (42/593), respectively, with the highest CRC prevalence in the 66-75 age group (≥12 times; odds ratio [OR], 12.11; 95% confidence interval [CI], 4.45-32.92). CRC and AA prevalence were inversely correlated with Asian descent, physical activity, and negative fecal immunochemical test results (OR=0.43; 95% CI, 0.22-0.83; OR=0.16; 95% CI, 0.04-0.68; OR=0.5; 95% CI, 0.07-3.85, respectively).
Conclusions Our study revealed high accuracy of CTC in diagnosing colonic neoplasms, good compliance with CTC screening, and high detection rate of CRC.
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Affiliation(s)
- Jandos Amankulov
- Department of Radiology and Nuclear Medicine, Kazakh Institute of Oncology and Radiology, Almaty, Kazakhstan.,Department of Visual Diagnostics, Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan
| | - Dilyara Kaidarova
- Department of Medical Oncology, Kazakh Institute of Oncology and Radiology, Almaty, Kazakhstan
| | - Zhamilya Zholdybay
- Department of Visual Diagnostics, Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan
| | - Marianna Zagurovskaya
- Department of Radiology, Medical College at the University of Kentucky, Lexington, KY, USA
| | - Nurlan Baltabekov
- Department of Medical Oncology, Kazakh Institute of Oncology and Radiology, Almaty, Kazakhstan
| | - Madina Gabdullina
- Department of Radiology and Nuclear Medicine, Kazakh Institute of Oncology and Radiology, Almaty, Kazakhstan
| | - Akmaral Ainakulova
- Department of Radiology and Nuclear Medicine, Kazakh Institute of Oncology and Radiology, Almaty, Kazakhstan.,Department of Visual Diagnostics, Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan
| | - Dias Toleshbayev
- Department of Radiology and Nuclear Medicine, Kazakh Institute of Oncology and Radiology, Almaty, Kazakhstan.,Department of Visual Diagnostics, Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan
| | - Alexandra Panina
- Department of Radiology and Nuclear Medicine, Kazakh Institute of Oncology and Radiology, Almaty, Kazakhstan.,Department of Visual Diagnostics, Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan
| | - Elvira Satbayeva
- Center of Morphological Diagnostics, Kazakh Institute of Oncology and Radiology, Almaty, Kazakhstan
| | - Zhansaya Kalieva
- Department of Endoscopy, Kazakh Institute of Oncology and Radiology, Almaty, Kazakhstan
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2
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Azulay R, Valinsky L, Hershkowitz F, Elran E, Lederman N, Kariv R, Braunstein B, Heymann A. Barriers to completing colonoscopy after a positive fecal occult blood test. Isr J Health Policy Res 2021; 10:11. [PMID: 33573698 PMCID: PMC7879608 DOI: 10.1186/s13584-021-00444-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 01/22/2021] [Indexed: 01/08/2023] Open
Abstract
Background Colorectal cancer leads to significant morbidity and mortality. Early detection and treatment are essential. Screening using fecal occult blood tests has increased significantly, but adherence to colonoscopy follow-up is suboptimal, increasing CRC mortality risk. The aim of this study was to identify barriers to colonoscopy following a positive FOBT at the level of the patient, physician, organization and policymakers. Methods This mixed methods study was conducted at two health care organizations in Israel. The study included retrospective analyses of 45,281 50–74 year-old members with positive fecal immunochemical tests from 2010 to 2014, and a survey of 772 patients with a positive test during 2015, with and without follow-up. The qualitative part of the study included focus groups with primary physicians and gastroenterologists and in-depth interviews with opinion leaders in healthcare. Results Patient lack of comprehension regarding the test was the strongest predictor of non-adherence to follow-up. Older age, Arab ethnicity, and lower socio economic status significantly reduced adherence. We found no correlation with gender, marital status, patient activation, waiting time for appointments or distance from gastroenterology clinics. Primary care physicians underestimate non-adherence rates. They feel responsible for patient follow-up, but express lack of time and skills that will allow them to ensure adherence among their patients. Gastroenterologists do not consider fecal occult blood an effective tool for CRC detection, and believe that all patients should undergo colonoscopy. Opinion leaders in the healthcare field do not prioritize the issue of follow-up after a positive screening test for colorectal cancer, although they understand the importance. Conclusions We identified important barriers that need to be addressed to improve the effectiveness of the screening program. Targeted interventions for populations at risk for non-adherence, specifically for those with low literacy levels, and better explanation of the need for follow-up as a routine need to be set in place. Lack of agreement between screening recommendations and gastroenterologist opinion, and lack of awareness among healthcare authority figures negatively impact the screening program need to be addressed at the organizational and national level. Trial registration This study was approved by the IRB in both participating organizations (Meuhedet Health Care Institutional Review Board #02–2–5-15, Maccabi Healthcare Institutional Review Board BBI-0025-16). Participant consent was waived by both IRB’s.
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Affiliation(s)
| | - Liora Valinsky
- Public Health Nursing, Ministry of Health, Jerusalem, Israel
| | | | - Einat Elran
- Maccabi Healthcare Services, Tel aviv, Israel
| | | | - Revital Kariv
- Maccabi Healthcare Services, Tel aviv, Israel.,Faculty of medicine University of Tel Aviv, Tel Aviv, Israel
| | | | - Anthony Heymann
- Meuhedet Health Care, 5 Pesach Lev, Lod, Israel.,Faculty of medicine University of Tel Aviv, Tel Aviv, Israel
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3
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Spada C, Hassan C, Bellini D, Burling D, Cappello G, Carretero C, Dekker E, Eliakim R, de Haan M, Kaminski MF, Koulaouzidis A, Laghi A, Lefere P, Mang T, Milluzzo SM, Morrin M, McNamara D, Neri E, Pecere S, Pioche M, Plumb A, Rondonotti E, Spaander MC, Taylor S, Fernandez-Urien I, van Hooft JE, Stoker J, Regge D. Imaging alternatives to colonoscopy: CT colonography and colon capsule. European Society of Gastrointestinal Endoscopy (ESGE) and European Society of Gastrointestinal and Abdominal Radiology (ESGAR) Guideline - Update 2020. Endoscopy 2020; 52:1127-1141. [PMID: 33105507 DOI: 10.1055/a-1258-4819] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
1: ESGE/ESGAR recommend computed tomographic colonography (CTC) as the radiological examination of choice for the diagnosis of colorectal neoplasia.Strong recommendation, high quality evidence.ESGE/ESGAR do not recommend barium enema in this setting.Strong recommendation, high quality evidence. 2: ESGE/ESGAR recommend CTC, preferably the same or next day, if colonoscopy is incomplete. The timing depends on an interdisciplinary decision including endoscopic and radiological factors.Strong recommendation, low quality evidence.ESGE/ESGAR suggests that, in centers with expertise in and availability of colon capsule endoscopy (CCE), CCE preferably the same or the next day may be considered if colonoscopy is incomplete.Weak recommendation, low quality evidence. 3: When colonoscopy is contraindicated or not possible, ESGE/ESGAR recommend CTC as an acceptable and equally sensitive alternative for patients with alarm symptoms.Strong recommendation, high quality evidence.Because of lack of direct evidence, ESGE/ESGAR do not recommend CCE in this situation.Very low quality evidence.ESGE/ESGAR recommend CTC as an acceptable alternative to colonoscopy for patients with non-alarm symptoms.Strong recommendation, high quality evidence.In centers with availability, ESGE/ESGAR suggests that CCE may be considered in patients with non-alarm symptoms.Weak recommendation, low quality evidence. 4: Where there is no organized fecal immunochemical test (FIT)-based population colorectal screening program, ESGE/ESGAR recommend CTC as an option for colorectal cancer screening, providing the screenee is adequately informed about test characteristics, benefits, and risks, and depending on local service- and patient-related factors.Strong recommendation, high quality evidence.ESGE/ESGAR do not suggest CCE as a first-line screening test for colorectal cancer.Weak recommendation, low quality evidence. 5: ESGE/ESGAR recommend CTC in the case of a positive fecal occult blood test (FOBT) or FIT with incomplete or unfeasible colonoscopy, within organized population screening programs.Strong recommendation, moderate quality evidence.ESGE/ESGAR also suggest the use of CCE in this setting based on availability.Weak recommendation, moderate quality evidence. 6: ESGE/ESGAR suggest CTC with intravenous contrast medium injection for surveillance after curative-intent resection of colorectal cancer only in patients in whom colonoscopy is contraindicated or unfeasibleWeak recommendation, low quality evidence.There is insufficient evidence to recommend CCE in this setting.Very low quality evidence. 7: ESGE/ESGAR suggest CTC in patients with high risk polyps undergoing surveillance after polypectomy only when colonoscopy is unfeasible.Weak recommendation, low quality evidence.There is insufficient evidence to recommend CCE in post-polypectomy surveillance.Very low quality evidence. 8: ESGE/ESGAR recommend against CTC in patients with acute colonic inflammation and in those who have recently undergone colorectal surgery, pending a multidisciplinary evaluation.Strong recommendation, low quality evidence. 9: ESGE/ESGAR recommend referral for endoscopic polypectomy in patients with at least one polyp ≥ 6 mm detected at CTC or CCE.Follow-up CTC may be clinically considered for 6 - 9-mm CTC-detected lesions if patients do not undergo polypectomy because of patient choice, comorbidity, and/or low risk profile for advanced neoplasia.Strong recommendation, moderate quality evidence.
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Affiliation(s)
- Cristiano Spada
- Digestive Endoscopy Unit and Gastroenterology, Fondazione Poliambulanza, Brescia, Italy.,Department of Gastroenterology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Cesare Hassan
- Gastroenterology Unit, Nuovo Regina Margherita Hospital, Rome, Italy
| | - Davide Bellini
- Department of Radiological Sciences, Oncology and Pathology, La Sapienza University of Rome, Diagnostic Imaging Unit, I.C.O.T. Hospital Latina, Italy
| | | | - Giovanni Cappello
- Radiology Unit, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Turin, Italy
| | - Cristina Carretero
- Department of Gastroenterology. University of Navarre Clinic, Healthcare Research Institute of Navarre, Pamplona, Spain
| | - Evelien Dekker
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Center location AMC, The Netherlands
| | - Rami Eliakim
- Department of Gastroenterology, Sheba Medical Center , Sackler School of Medicine, Tel-Aviv, Israel
| | - Margriet de Haan
- Department of Radiology, University Medical Center, Utrecht, The Netherlands
| | - Michal F Kaminski
- Departments of Gastroenterological Oncology and Cancer Prevention, The Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Anastasios Koulaouzidis
- Endoscopy Unit, Centre for Liver and Digestive Disorders, University Hospitals, NHS Lothian, Edinburgh, UK
| | - Andrea Laghi
- Department of Surgical-Medical Sciences and Translational Medicine, La Sapienza University of Rome, Italy
| | - Philippe Lefere
- Department of Radiology, Stedelijk Ziekenhuis, Roeselare, Belgium
| | - Thomas Mang
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Sebastian Manuel Milluzzo
- Digestive Endoscopy Unit and Gastroenterology, Fondazione Poliambulanza, Brescia, Italy.,Department of Gastroenterology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Martina Morrin
- RCSI Radiology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Deirdre McNamara
- TAGG Research Centre, Department of Clinical Medicine, Trinity Centre, Tallaght Hospital, Dublin, Ireland
| | - Emanuele Neri
- Diagnostic Radiology 3, Department of Translational Research, University of Pisa, Italy
| | - Silvia Pecere
- Department of Gastroenterology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Mathieu Pioche
- Endoscopy and Gastroenterology Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Andrew Plumb
- Centre for Medical Imaging, University College London, London, UK
| | | | - Manon Cw Spaander
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Stuart Taylor
- Centre for Medical Imaging, University College London, London, UK
| | | | - Jeanin E van Hooft
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, The Netherlands
| | - Jaap Stoker
- Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Daniele Regge
- Radiology Unit, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Turin, Italy.,University of Turin Medical School, Turin, Italy
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4
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Spada C, Hassan C, Bellini D, Burling D, Cappello G, Carretero C, Dekker E, Eliakim R, de Haan M, Kaminski MF, Koulaouzidis A, Laghi A, Lefere P, Mang T, Milluzzo SM, Morrin M, McNamara D, Neri E, Pecere S, Pioche M, Plumb A, Rondonotti E, Spaander MC, Taylor S, Fernandez-Urien I, van Hooft JE, Stoker J, Regge D. Imaging alternatives to colonoscopy: CT colonography and colon capsule. European Society of Gastrointestinal Endoscopy (ESGE) and European Society of Gastrointestinal and Abdominal Radiology (ESGAR) Guideline – Update 2020. Eur Radiol 2020; 31:2967-2982. [PMID: 33104846 DOI: 10.1007/s00330-020-07413-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Cristiano Spada
- Digestive Endoscopy Unit and Gastronenterology, Fondazione Poliambulanza, Brescia, Italy.
- Department of Gastroenterology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Cesare Hassan
- Gastroenterology Unit, Nuovo Regina Margherita Hospital, Rome, Italy
| | - Davide Bellini
- Department of Radiological Sciences, Oncology and Pathology, Diagnostic Imaging Unit, La Sapienza University of Rome, I.C.O.T. Hospital, Latina, Italy
| | | | - Giovanni Cappello
- Radiology Unit, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Turin, Italy
| | - Cristina Carretero
- Department of Gastroenterology, University of Navarre Clinic, Healthcare Research Institute of Navarre, Pamplona, Spain
| | - Evelien Dekker
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Center location AMC, Amsterdam, The Netherlands
| | - Rami Eliakim
- Department of Gastroenterology, Sheba Medical Center, Sackler School of Medicine, Tel-Aviv, Israel
| | - Margriet de Haan
- Department of Radiology, University Medical Center, Utrecht, The Netherlands
| | - Michal F Kaminski
- Departments of Gastroenterological Oncology and Cancer Prevention, The Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Anastasios Koulaouzidis
- Endoscopy Unit, Centre for Liver and Digestive Disorders, University Hospitals, NHS Lothian, Edinburgh, UK
| | - Andrea Laghi
- Department of Surgical-Medical Sciences and Translational Medicine, La Sapienza University of Rome, Rome, Italy
| | - Philippe Lefere
- Department of Radiology, Stedelijk Ziekenhuis, Roeselare, Belgium
| | - Thomas Mang
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Sebastian Manuel Milluzzo
- Digestive Endoscopy Unit and Gastronenterology, Fondazione Poliambulanza, Brescia, Italy
- Department of Gastroenterology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Martina Morrin
- RCSI Radiology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Deirdre McNamara
- TAGG Research Centre, Department of Clinical Medicine, Trinity Centre, Tallaght Hospital, Dublin, Ireland
| | - Emanuele Neri
- Diagnostic Radiology 3, Department of Translational Research, University of Pisa, Pisa, Italy
| | - Silvia Pecere
- Department of Gastroenterology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Mathieu Pioche
- Endoscopy and Gastroenterology Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Andrew Plumb
- Centre for Medical Imaging, University College London, London, UK
| | | | - Manon Cw Spaander
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Stuart Taylor
- Centre for Medical Imaging, University College London, London, UK
| | | | - Jeanin E van Hooft
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jaap Stoker
- Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Daniele Regge
- Radiology Unit, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Turin, Italy
- University of Turin Medical School, Turin, Italy
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5
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Kaushal A, Stoffel ST, Kerrison R, von Wagner C. Preferences for different diagnostic modalities to follow up abnormal colorectal cancer screening results: a hypothetical vignette study. BMJ Open 2020; 10:e035264. [PMID: 32713846 PMCID: PMC7383951 DOI: 10.1136/bmjopen-2019-035264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES In England, a significant proportion of people who take part in the national bowel cancer screening programme (BCSP) and have a positive faecal occult blood test (FOBt) result, do not attend follow-up colonoscopy (CC). The aim of this study was to investigate differences in intended participation in a follow-up investigation by diagnostic modality offered including CC, CT colonography (CTC) or capsule endoscopy (CE). SETTING We performed a randomised online experiment with individuals who had previously completed an FOBt as part of the English BCSP. METHODS Participants (n=953) were randomly allocated to receive one of three online vignettes asking participants to imagine they had received an abnormal FOBt result, and that they had been invited for a follow-up test. The follow-up test offered was either: CC (n=346), CTC (n=302) or CE (n=305). Participants were then asked how likely they were to have their allocated test or if they refused, either of the other tests. Respondents were also asked to cite possible emotional and practical barriers to follow up testing. Multivariable logistic regression models were used to investigate intentions. RESULTS Intention to have the test was higher in the CTC group (96.7%) compared with the CC group (91.8%; OR 2.64; 95% CI 1.22 to 5.73). CTC was considered less 'off-putting' (OR 0.66, 95% CI 0.47 to 0.94) and less uncomfortable compared with CC (OR 0.51, 95% CI 0.34 to 0.77). For those who did not intend to have the test they were offered, CE (39.7%) or no investigation (34.5%) was preferable to CC (8.6%) or CTC (17.2%). CONCLUSIONS Alternative tests have the potential to increase attendance at diagnostic follow-up appointments.
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Affiliation(s)
- Aradhna Kaushal
- Research Department of Behavioural Science and Health, University College London, London, UK
| | - Sandro Tiziano Stoffel
- Research Department of Behavioural Science and Health, University College London, London, UK
- European Center of Pharmaceutical Medicine, University of Basel, Basel, Switzerland
| | - Robert Kerrison
- Research Department of Behavioural Science and Health, University College London, London, UK
| | - Christian von Wagner
- Research Department of Behavioural Science and Health, University College London, London, UK
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Cossu G, Saba L, Minerba L, Mascalchi M. Colorectal Cancer Screening: The Role of Psychological, Social and Background Factors in Decision-making Process. Clin Pract Epidemiol Ment Health 2018; 14:63-69. [PMID: 29643929 PMCID: PMC5872199 DOI: 10.2174/1745017901814010063] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Revised: 02/08/2018] [Accepted: 02/19/2018] [Indexed: 12/27/2022]
Abstract
Since ColoRectal Cancer (CRC) remains the third cause of cancer death in the world, a better understanding of the reasons underlying poor adherence to and delay in undergoing CRC screening programs is important. CRC screening decision-making process can be conceptualized as the relationship between intention and behavior and needs to be investigated including the impact on patients' decision of a broad range of psychological factors and personal predisposition as fear of a positive screening test, poor understanding of the procedure, psychological distress, anxiety, anticipation of pain, feelings of embarrassment and vulnerability. Also socioeconomic, ethnic and sociological influences, and organizational barriers have been identified as factors influencing CRC screening adherence. Decision-making process can finally be influenced by the healthcare background in which the intervention is promoted and screening programs are carried out. However, there is still a gap on the scientific knowledge about the influences of diverse elements on screening adherence and this deserves further investigations in order to carry out more focused and effective prevention programs.
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Affiliation(s)
- Giulia Cossu
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Luca Saba
- Department of Radiology, AOU, University of Cagliari, Cagliari, Italy
| | - Luigi Minerba
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Mario Mascalchi
- Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
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7
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Sali L, Grazzini G, Mascalchi M. CT colonography: role in FOBT-based screening programs for colorectal cancer. Clin J Gastroenterol 2017; 10:312-319. [PMID: 28447326 DOI: 10.1007/s12328-017-0744-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 04/18/2017] [Indexed: 01/28/2023]
Abstract
Computed tomographic colonography (CTC) is a minimally invasive imaging examination for the colon, and is safe, well tolerated and accurate for the detection of colorectal cancer (CRC) and advanced adenoma. While the role of CTC as a primary test for population screening of CRC is under investigation, the fecal occult blood test (FOBT) has been recommended for population screening of CRC in Europe. Subjects with positive FOBT are invited to undergo total colonoscopy, which has some critical issues, such as suboptimal compliance, contraindications and the possibility of an incomplete exploration of the colon. Based on available data, the integration of CTC in FOBT-based population screening programs for CRC may fall into three scenarios. First, CTC is recommended in FOBT-positive subjects when colonoscopy is refused, incomplete or contraindicated. For these indications CTC should replace double-contrast barium enema. Second, conversely, CTC is not currently recommended as a second-level examination prior to colonoscopy in all FOBT-positive subjects, as this strategy is most probably not cost-effective. Finally, CTC may be considered instead of colonoscopy for surveillance after adenoma removal, but specific studies are needed.
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Affiliation(s)
- Lapo Sali
- Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", University of Florence, Viale Morgagni 50, 50134, Florence, Italy.
| | - Grazia Grazzini
- Cancer Prevention and Research Institute (ISPO), Via Cosimo il Vecchio 2, 50139, Florence, Italy
| | - Mario Mascalchi
- Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", University of Florence, Viale Morgagni 50, 50134, Florence, Italy
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8
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Plumb AA, Ghanouni A, Rainbow S, Djedovic N, Marshall S, Stein J, Taylor SA, Halligan S, Lyratzopoulos G, von Wagner C. Patient factors associated with non-attendance at colonoscopy after a positive screening faecal occult blood test. J Med Screen 2017; 24:12-19. [PMID: 27216771 DOI: 10.1177/0969141316645629] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2024]
Abstract
Background Screening participants with abnormal faecal occult blood test results who do not attend further testing are at high risk of colorectal cancer, yet little is known about their reasons for non-attendance. Methods We conducted a medical record review of 170 patients from two English Bowel Cancer Screening Programme centres who had abnormal guaiac faecal occult blood test screening tests between November 2011 and April 2013 but did not undergo colonoscopy. Using information from patient records, we coded and categorized reasons for non-attendance. Results Of the 170 patients, 82 were eligible for review, of whom 66 had at least one recorded reason for lack of colonoscopy follow-up. Reasons fell into seven main categories: (i) other commitments, (ii) unwillingness to have the test, (iii) a feeling that the faecal occult blood test result was a false positive, (iv) another health issue taking priority, (v) failing to complete bowel preparation, (vi) practical barriers (e.g. lack of transport), and (vii) having had or planning colonoscopy elsewhere. The most common single reasons were unwillingness to have a colonoscopy and being away. Conclusions We identify a range of apparent reasons for colonoscopy non-attendance after a positive faecal occult blood test screening. Education regarding the interpretation of guaiac faecal occult blood test findings, offer of alternative confirmatory test options, and flexibility in the timing or location of subsequent testing might decrease non-attendance of diagnostic testing following positive faecal occult blood test.
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Affiliation(s)
- Andrew A Plumb
- 1 Centre for Medical Imaging, University College London, London, UK
| | - Alex Ghanouni
- 2 Health Behaviour Research Centre, University College London, London, UK
| | - Sandra Rainbow
- 3 London Hub, Bowel Cancer Screening Programme, Northwick Park Hospital, Harrow, UK
| | - Natasha Djedovic
- 3 London Hub, Bowel Cancer Screening Programme, Northwick Park Hospital, Harrow, UK
| | - Sarah Marshall
- 4 St Marks Screening Centre, St Marks Hospital, Harrow, UK
| | - Judith Stein
- 5 University College Screening Centre, University College London Hospitals, London, UK
| | - Stuart A Taylor
- 1 Centre for Medical Imaging, University College London, London, UK
| | - Steve Halligan
- 1 Centre for Medical Imaging, University College London, London, UK
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9
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Sali L, Regge D. CT colonography for population screening of colorectal cancer: hints from European trials. Br J Radiol 2016; 89:20160517. [PMID: 27542076 DOI: 10.1259/bjr.20160517] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
CT colonography (CTC) is a minimally invasive radiological investigation of the colon. Robust evidence indicates that CTC is safe, well tolerated and highly accurate for the detection of colorectal cancer (CRC) and large polyps, which are the targets of screening. Randomized controlled trials were carried out in Europe to evaluate CTC as the primary test for population screening of CRC in comparison with faecal immunochemical test (FIT), sigmoidoscopy and colonoscopy. Main outcomes were participation rate and detection rate. Participation rate for screening CTC was in the range of 25-34%, whereas the detection rate of CTC for CRC and advanced adenoma was in the range of 5.1-6.1%. Participation for CTC screening was lower than that for FIT, similar to that for sigmoidoscopy and higher than that for colonoscopy. The detection rate of CTC was higher than that of one FIT round, similar to that of sigmoidoscopy and lower than that of colonoscopy. However, owing to the higher participation rate in CTC screening with respect to colonoscopy screening, the detection rates per invitee of CTC and colonoscopy would be comparable. These results justify consideration of CTC in organized screening programmes for CRC. However, assessment of other factors such as polyp size threshold for colonoscopy referral, management of extracolonic findings and, most importantly, the forthcoming results of cost-effectiveness analyses are crucial to define the role of CTC in primary screening.
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Affiliation(s)
- Lapo Sali
- 1 Department of Biomedical Experimental and Clinical Sciences Mario Serio, University of Florence, Florence, Italy
| | - Daniele Regge
- 2 Dipartimento di Scienze Chirurgiche, Università di Torino, Turin, Italy.,3 Candiolo Cancer Institute FPO, IRCCS, Turin, Italy
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Abstract
Computed tomographic colonography (CTC) is a minimally invasive, patient-friendly, safe and robust colonic imaging modality. The technique is standardized and consolidated evidence from the literature shows that the diagnostic performances for the detection of colorectal cancer and large polyps are similar to colonoscopy (CS) and largely superior to alternative radiological exams, like barium enema. A clear understanding of the exact role of CTC will be beneficial to maximize the benefits and minimize the potential sources of frustration or disappointment for both referring clinicians and patients. Incomplete, failed, or unfeasible CS; investigation of elderly, and frail patients and assessment of diverticular disease are major indications supported by evidence-based data and agreed by the endoscopists. The use of CTC for symptomatic patients, colorectal cancer screening and colonic surveillance is still under debate and, thus, recommended only if CS is unfeasible or refused by patients.
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Affiliation(s)
- Andrea Laghi
- a Department of Radiological Sciences, Oncology and Pathology , Sapienza - University of Rome, ICOT Hospital , Latina , Italy
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Plumb AA, Taylor SA, Halligan S. Effect of faecal occult blood positivity on detection rates and positive predictive value of CT colonography when screening for colorectal neoplasia. Clin Radiol 2015; 70:1104-9. [PMID: 26145187 DOI: 10.1016/j.crad.2015.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2015] [Revised: 05/06/2015] [Accepted: 05/28/2015] [Indexed: 10/23/2022]
Abstract
AIM To determine the detection rates and positive predictive value (PPV) of computed tomography (CT) colonography (CTC) according to the magnitude of faecal occult blood test (FOBt) positivity. MATERIALS AND METHODS Anonymised data from individuals undergoing CTC after a positive FOBt in the English Bowel Cancer Screening Programme were analysed. The detection of colorectal cancer (CRC), advanced neoplasia, and ≥ 6 mm polyps were stratified by the number of positive FOBt windows. The PPV was calculated by reference to subsequent endoscopy results. The influence of the FOBt result on detection rates was estimated with multilevel logistic regression. PPV, CRC stage, and location were compared across groups according to FOBt positivity. RESULTS Four thousand, six hundred and one individuals were included (mean = 66.7 years, 54.2% men). Detection rates of CRC and advanced neoplasia increased with greater numbers of positive FOBt windows (odds ratio [OR] for CRC = 1.41; 95% confidence interval [CI]: 1.31-1.52; OR for advanced neoplasia = 1.17; 95%CI: 1.12-1.23; both p < 0.0001). The PPV was significantly greater at higher FOBt levels (p = 0.020). The number of positive FOBt windows had no significant effect on stage (p = 0.30) or location (p = 0.20) of confirmed CRC. CONCLUSIONS The magnitude of FOBt positivity influences the PPV and detection rates when screening for colorectal neoplasia. CTC may be particularly useful for FOBt patients with few positive test windows.
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Affiliation(s)
- A A Plumb
- Centre for Medical Imaging, Podium Level 2, University College Hospital, 235 Euston Rd, London NW1 2BU, UK.
| | - S A Taylor
- Centre for Medical Imaging, Podium Level 2, University College Hospital, 235 Euston Rd, London NW1 2BU, UK
| | - S Halligan
- Centre for Medical Imaging, Podium Level 2, University College Hospital, 235 Euston Rd, London NW1 2BU, UK
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12
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Clinical indications for computed tomographic colonography: European Society of Gastrointestinal Endoscopy (ESGE) and European Society of Gastrointestinal and Abdominal Radiology (ESGAR) Guideline. Eur Radiol 2015; 25:331-45. [PMID: 25278245 PMCID: PMC4291518 DOI: 10.1007/s00330-014-3435-z] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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13
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Laghi A, Bellini D, Petrozza V, Piccazzo R, Santoro GA, Fabbri C, van der Paardt MP, Stoker J. Imaging of colorectal polyps and early rectal cancer. Colorectal Dis 2015; 17 Suppl 1:36-43. [PMID: 25511860 DOI: 10.1111/codi.12820] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- A Laghi
- Department of Radiological Sciences, Oncology and Pathology, "SAPIENZA" University of Rome, I.C.O.T. Hospital, Latina, Italy
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Laghi A. Computed tomography colonography in 2014: an update on technique and indications. World J Gastroenterol 2014; 20:16858-67. [PMID: 25492999 PMCID: PMC4258555 DOI: 10.3748/wjg.v20.i45.16858] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Revised: 08/27/2014] [Accepted: 10/14/2014] [Indexed: 02/06/2023] Open
Abstract
Twenty years after its introduction, computed tomographic colonography (CTC) has reached its maturity, and it can reasonably be considered the best radiological diagnostic test for imaging colorectal cancer (CRC) and polyps. This examination technique is less invasive than colonoscopy (CS), easy to perform, and standardized. Reduced bowel preparation and colonic distention using carbon dioxide favor patient compliance. Widespread implementation of a new image reconstruction algorithm has minimized radiation exposure, and the use of dedicated software with enhanced views has enabled easier image interpretation. Integration in the routine workflow of a computer-aided detection algorithm reduces perceptual errors, particularly for small polyps. Consolidated evidence from the literature shows that the diagnostic performances for the detection of CRC and large polyps in symptomatic and asymptomatic individuals are similar to CS and are largely superior to barium enema, the latter of which should be strongly discouraged. Favorable data regarding CTC performance open the possibility for many different indications, some of which are already supported by evidence-based data: incomplete, failed, or unfeasible CS; symptomatic, elderly, and frail patients; and investigation of diverticular disease. Other indications are still being debated and, thus, are recommended only if CS is unfeasible: the use of CTC in CRC screening and in surveillance after surgery for CRC or polypectomy. In order for CTC to be used appropriately, contraindications such as acute abdominal conditions (diverticulitis or the acute phase of inflammatory bowel diseases) and surveillance in patients with a long-standing history of ulcerative colitis or Crohn's disease and in those with hereditary colonic syndromes should not be overlooked. This will maximize the benefits of the technique and minimize potential sources of frustration or disappointment for both referring clinicians and patients.
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15
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Zorzi M, Giorgi Rossi P, Cogo C, Falcini F, Giorgi D, Grazzini G, Mariotti L, Matarese V, Soppelsa F, Senore C, Ferro A. A comparison of different strategies used to invite subjects with a positive faecal occult blood test to a colonoscopy assessment. A randomised controlled trial in population-based screening programmes. Prev Med 2014; 65:70-6. [PMID: 24811759 DOI: 10.1016/j.ypmed.2014.04.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Revised: 04/23/2014] [Accepted: 04/28/2014] [Indexed: 12/19/2022]
Abstract
OBJECTIVE The purpose of this parallel randomised controlled trial was to compare compliance with different modalities used to invite patients with a positive immunochemical faecal occult blood test (FIT+) for a total colonoscopy (TC). METHOD FIT+ patients from nine Italian colorectal cancer screening programmes were randomised to be invited for a TC initially by mail or by phone and, for non-compliers, to be recalled by mail, for counselling with a general practitioner, or to meet with a specialist screening practitioner (nurse or healthcare assistant). RESULTS In all, 3777 patients were randomised to different invitation strategies. Compliance with an initial invitation by mail and by phone was similar (86.0% vs. 84.0%, relative risk - RR: 1.02; 95%CI 0.97-1.08). Among non-responders to the initial invitation, compliance with a recall by appointment with a specialist practitioner was 50.4%, significantly higher than with a mail recall (38.1%; RR:1.33; 95%CI 1.01-1.76) or with a face-to-face counselling with the GP (30.8%; RR:1.45;95%CI 1.14-1.87). CONCLUSION Compliance with an initial invitation for a TC by mail and by phone was similar. A personal meeting with a specialist screening practitioner was associated with the highest compliance among non-compliers with initial invitations, while the involvement of GPs in this particular activity seemed less effective.
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Affiliation(s)
- Manuel Zorzi
- Registro Tumori del Veneto, Passaggio Gaudenzio 1, Padova, Italy.
| | - Paolo Giorgi Rossi
- Servizio Interaziendale Epidemiologia, Azienda Sanitaria Locale di Reggio Emilia, via Amendola 2, Reggio Emilia, Italy.
| | - Carla Cogo
- Registro Tumori del Veneto, Passaggio Gaudenzio 1, Padova, Italy.
| | - Fabio Falcini
- Unità Operativa di Prevenzione Oncologica, Ospedale Civile G.B. Morgagni L. Pierantoni, AUSL di Forlì, via Forlanini 34, Forlì, Italy.
| | - Daniela Giorgi
- S.C. Epidemiologia e Screening, Azienda Sanitaria Locale 2 di Lucca, via per Sant'Alessio - Monte San Quirico, Lucca, Italy.
| | - Grazia Grazzini
- Screening Unit Cancer Prevention and Research Institute ISPO, via Cosimo il Vecchio 2, Firenze, Italy.
| | - Loretta Mariotti
- Laboratorio Unico di Screening, Azienda Sanitaria Locale 2 di Perugia, via XIV settembre 75, Perugia, Italy.
| | - Vincenzo Matarese
- Unità Operativa di Gastroenterologia, Azienda Ospedaliero-Universitaria S. Anna, Cona-Ferrara, via Moro 8, Cona,FE, Italy.
| | - Fabio Soppelsa
- Dipartimento di Prevenzione, Azienda Sanitaria Locale 1 di Belluno, via S. Andrea 8, Belluno, Italy.
| | - Carlo Senore
- Centro per la Prevenzione Oncologica (CPO), via San Francesco da Paola 31, Torino, Italy.
| | - Antonio Ferro
- Dipartimento di Prevenzione, Azienda Sanitaria Locale 17 di Este Monselice, via Francesconi 2, Este,PD, Italy.
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Helbren E, Roth HR, Hampshire TE, Pickhardt PJ, Taylor SA, Hawkes DJ, Halligan S. CT colonography: clinical evaluation of a method for automatic coregistration of polyps at follow-up surveillance studies. Radiology 2014; 273:417-24. [PMID: 24991991 DOI: 10.1148/radiol.14140473] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To evaluate the accuracy of a method of automatic coregistration of the endoluminal surfaces at computed tomographic (CT) colonography performed on separate occasions to facilitate identification of polyps in patients undergoing polyp surveillance. MATERIALS AND METHODS Institutional review board and HIPAA approval were obtained. A registration algorithm that was designed to coregister the coordinates of endoluminal colonic surfaces on images from prone and supine CT colonographic acquisitions was used to match polyps in sequential studies in patients undergoing polyp surveillance. Initial and follow-up CT colonographic examinations in 26 patients (35 polyps) were selected and the algorithm was tested by means of two methods, the longitudinal method (polyp coordinates from the initial prone and supine acquisitions were used to identify the expected polyp location automatically at follow-up CT colonography) and the consistency method (polyp coordinates from the initial supine acquisition were used to identify polyp location on images from the initial prone acquisition, then on those for follow-up prone and follow-up supine acquisitions). Two observers measured the Euclidean distance between true and expected polyp locations, and mean per-patient registration accuracy was calculated. Segments with and without collapse were compared by using the Kruskal-Wallace test, and the relationship between registration error and temporal separation was investigated by using the Pearson correlation. RESULTS Coregistration was achieved for all 35 polyps by using both longitudinal and consistency methods. Mean ± standard deviation Euclidean registration error for the longitudinal method was 17.4 mm ± 12.1 and for the consistency method, 26.9 mm ± 20.8. There was no significant difference between these results and the registration error when prone and supine acquisitions in the same study were compared (16.9 mm ± 17.6; P = .451). CONCLUSION Automatic endoluminal coregistration by using an algorithm at initial CT colonography allowed prediction of endoluminal polyp location at subsequent CT colonography, thereby facilitating detection of known polyps in patients undergoing CT colonographic surveillance.
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Affiliation(s)
- Emma Helbren
- From the Centre for Medical Imaging (E.H., S.T., S.H.) and Centre for Medical Image Computing (H.R., T.H., D.H.), University College London, 3rd Floor East, 250 Euston Road, London NW1 2PG, England; and Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (P.J.P.)
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Sali L, Falchini M, Taddei A, Mascalchi M. Role of preoperative CT colonography in patients with colorectal cancer. World J Gastroenterol 2014; 20:3795-3803. [PMID: 24744573 PMCID: PMC3983437 DOI: 10.3748/wjg.v20.i14.3795] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Revised: 01/01/2014] [Accepted: 01/20/2014] [Indexed: 02/06/2023] Open
Abstract
In patients with colorectal cancer (CRC), accurate preoperative evaluation is essential for a correct therapeutic plan. Colonoscopy and intravenous contrast-enhanced computed tomography (CT) are currently recommended in the preoperative work-up for CRC. Preoperative colonoscopy has some limitations such as misdiagnosis of synchronous cancers in cases of incomplete exploration of the colon and inaccurate tumor localization. Intravenous contrast-enhanced CT successfully documents distant metastases although it sometimes enables unsatisfactory locoregional staging. Computed tomography colonography (CTC) is obtained after gas insufflation of the colon and offers a comprehensive preoperative evaluation in patients with CRC, including a definition of the segmental location of the tumor, presence of synchronous lesions or lack thereof, and fairly accurate locoregional staging. CTC has some limitations, including a lack of biopsy capability, suboptimal sensitivity for synchronous small polyps, and unsatisfactory nodal staging. Bearing in mind these limitations, CTC could be employed as a “one-stop-shop” examination for preoperative assessment in patients with CRC.
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Zavoral M, Suchanek S, Majek O, Fric P, Minarikova P, Minarik M, Seifert B, Dusek L. Colorectal cancer screening: 20 years of development and recent progress. World J Gastroenterol 2014; 20:3825-3834. [PMID: 24744575 PMCID: PMC3983439 DOI: 10.3748/wjg.v20.i14.3825] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2013] [Revised: 11/22/2013] [Accepted: 01/06/2014] [Indexed: 02/06/2023] Open
Abstract
Colorectal cancer (CRC) is the second most common cancer in Europe and its incidence is steadily increasing. This trend could be reversed through timely secondary prevention (screening). In the last twenty years, CRC screening programs across Europe have experienced considerable improvements (fecal occult blood testing; transition from opportunistic to population based program settings). The Czech Republic is a typical example of a country with a long history of nationwide CRC screening programs in the face of very high CRC incidence and mortality rates. Each year, approximately 8000 people are diagnosed with CRC and some 4000 die from this malignancy. Twenty years ago, the first pilot studies on CRC screening led to the introduction of the opportunistic Czech National Colorectal Cancer Screening Program in 2000. Originally, this program was based on the guaiac fecal occult blood test (FOBT) offered by general practitioners, followed by colonoscopy in cases of FOBT positivity. The program has continuously evolved, namely with the implementation of immunochemical FOBTs and screening colonoscopy, as well as the involvement of gynecologists. Since the establishment of the Czech CRC Screening Registry in 2006, 2405850 FOBTs have been performed and 104565 preventive colonoscopies recorded within the screening program. The overall program expanded to cover 25.0% of the target population by 2011. However, stagnation in the annual number of performed FOBTs lately has led to switching to the option of a population-based program with personal invitation, which is currently being prepared.
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